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ink from chase. good morning from new york, i'm chris hayes. new jersey governor chris christie's administration has estimated the cost of the damage caused by hurricane sandy to the state will be nearly $30 billion. and protests continued in tahrir square this morning, granting himself sweeping new powers, we'll have more on continuing tensions in egypt tomorrow. right now, i'm joined by author
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of "life inc.," how we can take it back. author of "plutocrats," peter suterman, and co-owner of green light bookstore an independent bookstore in brooklyn. thanksgiving is a day set aside to celebrate family, community, your neighbors, a day to give thanksme thanks. only a few hours after this year came black friday. a different type of holiday. a time to celebrate american consumpti consumption. a time to elbow your neighbor in the eye socket for a steeply discounted flat screen tv. tens of millions shopped throughout america. but black friday has become more of a cultural symbol than an economic one. a beloved media story about the great lengths americans are willing to go to to get a deal. and there's no store that captures the essence of american consumerism in its costs more than walmart. walmart organizing workers
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across the country disrupted the consumption that defines black friday, reminding everyone there are workers involved in the equation. we talked to two of these workers last weekend. and yesterday, they were joined by hundreds of striking walmart workers across 46 states according to organizers. walmart for its part has said fewer than 50 associates across the country participated in the strike and triumphantly reported this black friday as their best yet. for organizations that have tried for years to bring attention to the labor practices of walmart and other big-box retailers, yesterday was undoubtedly a success. the strike elevated the millions of all forgotten retail workers who work every day for low wages and few benefits. i want to bring in greg fletcher, a walmart associate. he's a member of the group and was on strike yesterday. he joined us last week, he's back today to give us an update. tell me how yesterday went. >> yesterday went really, really well. in my store, which is in the los angeles area, we ended our protests with over 1,000 people.
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it started off small and, of course, as workers in the stores that were around us who weren't originally a part of it saw how big it got. they came out and joined us. and we ended up with about 1,500 people, approximately. >> i want to ask a question. there's a distinction here that's important from the perspective of what kind of threat this constitutes to walmart. people joining the protests who are from the community or sympathetic or even consumers and folks who actually like yourself are walmart associates who are putting their necks on the line and risking possible retaliation, although walmart claims they'll never retaliate, to take concerted labor action. how many people are in that latter category. my sense is that it is a relatively small number of people. >> well, we had -- we're still getting the numbers in as far as nationwide because we had so many of these actions. but, you know, the -- we had people in my particular demonstration, you know, coming
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in who weren't even signed up for it who weren't going to do it at first, but were emboldened by what we were doing. it was fantastic. >> my understanding is that you were arrested yesterday along with your wife who is also a walmart associate. how did that go down? >> well, actually, let me correct you. it was actually my brother and my wife. because of my two young kids -- >> you did not get arrested. i'm sorry. i'm sorry to say you got arrested on national television when you were not, in fact, arrested. >> that's okay. people get my brother and me mixed up all the time. it's all right. >> so -- this was a civil disobedience action to get arrested? >> well, it wasn't the intent. we didn't go out there with the idea that we were going to cause trouble and get arrested. but they understood the risk. and it was something to -- to make a point about what walmart does to its workers, how it
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treats them, they were willing to make that price, to risk it. >> do you think -- i think the key thing here, the question in terms of going forward. i mean people who have organized it say this is an escalation. my two questions for you are, do you worry about retaliation? you've been on our show twice, you're going to go back to work presumably. it's very easy to find other reasons you might be dismissed or penalized. and number two, where does this go from here? >> well, as far as retaliation against myself, it's something that i'll be honest, it's, i know the law and i know the rights and i've done everything in accordance to the law for that reason, for my own protection. but it is something that i do. i'm a little worried about. but, you know, the importance of what we're seeing is so important that i feel like risks have to be made. i have to do this. and i'm sorry, what was the other question? >> where does this go from here? obviously, it's been something the labor movement and workers
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inside stores and a whole bunch of people have been trying to build worker power inside walmart for a long time. and walmart has been very clever and deft at avoiding any kind of concentrated labor power. and i wonder what you see as the next step. >> well, just from the success of our actions yesterday and we're going to continue building this thing, continue the discussion with other workers, other associates. and, you know, again, we keep asking the company to just come to the table and talk with us about problems. and if they continue to avoid talking to us, dismissing their employees, dismissing those w whose families pay for their success, we might have to do this again. >> greg fletcher, walmart associate in california. appreciate you joining us today and give your brother-in-law and your wife my best. >> i will. thank you. so this is something that
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labor's been working out for a long time. and yesterday, i think, was bigger than anything that's ever happened in the labor actions against walmart. there's two ways to read what happened yesterday. there's one in the context of how many workers they have, which is 1.6 million associates and it's a massive operation, and so even if 100, 200, 1,000, or 15,000 people walk out, that's relatively small. the other way to look at it is in the history of walmart which has been resistant to any kind of concerted labor action. i'm curious on your take away from yesterday. >> well, i think it's not big enough yet to see this as the turning point. i do agree that in the history of walmart, this is a bigger deal than we've seen before. and i think the fact that it comes after the election and after occupy and occupy sandy, i think, was a big deal too. there was a little bit of a shift of how people are seeing labor and how people are seeing some of these whole sort of set of progressive ideas that some
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people said to quote lennon here, we're in the dust pan of history. maybe take them out of the garbage can and dust them off a bit, but far too early to proclaim victory. greg was clearly a highly educated, highly motivated guy. so many of the people who work there are really, i think, you know, much more on the edge, not people who know labor law very well. are not people who can afford in their personal lives to take that kind of a risk even if they believe it. so i think it's really, really hard. >> but even as -- you know, i didn't think of it until now, but the idea just as a media story, to have something that pictures americans as people other than these cows just storming in -- the thing i hate about the black friday is the way the media uses it as proof, well, this is the american consumer. and walmart and these companies aren't doing anything wrong because this is what people want. >> it's what we demand. >> we had an editorial debate
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yesterday about whether we were going to play one of these videos. i think we do have it cued up. the classic, like, stampede black friday video. and we that had this debate about one level are we allowing eight people to look at this video and feel comfortably smug and superior to, oh, look at those animals going for flat screen tvs. but this did happen and there's something -- >> -- to be validated in your own consumerist desires. you see that and you think, well, maybe i should go buy something too. >> peter, what's your thought on this? >> you call this a media event, and i think that's a much better way to look at this than as a real substantial meaningful labor of rising. >> you're talking about the walmart action as opposed to black friday. they're both media events. >> the walmart action. and, you know, so walmart says it was about 50 employees. let's give them the benefit of the doubt and say it was ten times that 500. i've seen them reporting in sympathetic outlets that say low
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hundred. that is less than 1/1000th of a percent. you'd have one or two people get mad at management, walk out and throw a fit, and that's a bigger percentage. >> is this a good thing? so even if we accept, okay, organized labor is dead and whatever, and we can't get tens of thousands out to do that. but instead, if the battle is now how do we change public perception of itself? how do we change americans from thinking of themselves as blind zombie consumers and instead help them think of themselves as people with agency who can make conscious choices isn't a media event the kind of event you want? >> one of the things that's interesting is when we talk about the modern economy, you'll hear something like the following phrase. well, the last 30 years of the american political economy has been very good for consumers, but bad for workers. well, it's not like there's two parts of me. it's just the same person who is doing both of those things. the question is in total, are
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you better off. and jennifer is someone who runs a small business and is in the world of retail. i want to hear what your thoughts on all of this right after we take this quick break.
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that's the video of the walmart in georgia on black friday that we were debating whether we wanted to show. so we thought -- >> we say voyeurism -- >> well, no, we said we're only going to show it if we unpack a little bit rather than just kind of throw it out and look at those crazy people.
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jessica, not jennifer. we're 14 minutes into the show, i got one person who wasn't arrested saying was arrested. what was your take away from the walmart action? >> i honestly think it's inspiring. we were talking about this a moment ago. i think like the occupy movement, even if it's a sort of a symbolic moment, it allows people to imagine a different kind of a world. and i think that's where all big things start. the idea of opening an independent bookstore, a lot of people were like, oh, that's a nice slightly crazy thing to do. you kind of have to be an optimist to make anything happen. and now we're real, 3-year-old $1.5 million a year business. >> you have an independent bookstore in brooklyn that you open. and when we talk about retail on the role it plays in america. i think there's this trend toward consolidation and bigness. and that has ways in which it affects business, in ways it affects independent retailers as
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yourself. and so as you watch the spectacle of black friday and think of the big competitors in your field, amazon being the biggest. why do you exist? i'm serious -- >> it's a good question. >> why do you exist now and will you exist years from now? >> obviously i'm kind of an optimist in general, but i think there has been in the last few years kind of a backlash against bigness and, you know, boxy, everything being gigantic. there's been an increase in buy locals. the american book sellers association, our bookstore is a member has been instrumental in trying to spread that word. and i think it's starting to catch on that there's more to buying things than getting the cheapest price. there's sort of having this human scale experience, where you're going to meet your neighbors, talk to people who know you, be in a sort of environment that's designed around people rather than around packing in as much product as possible. and we work on sort of creating this space that people want to be in. that's a big part of what we're
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selling as well as the books on the shelves. >> is that -- i'm sympathetic to that. there was a part of me that distrusts my like for shop local as this affectation. but basically, you know, yes, the question when we're thinking about where our politics come from. is the problem with amazon the fact that it's big, or is the fact that it is engaging in anti-competitive practices or its warehouse workers are getting, you know, there's so much heatstroke in one warehouse in pennsylvania that the emergency room doctor had to call osha. what is the content of this kind of sentiment that affection we have for smallness? >> so the thing that hasn't been brought up here that you have to talk about in order to talk about walmart as a cultural and economic force is prices. >> sure. >> and prices in local bookstores tend to be somewhat higher than they are on amazon, this is why people go to amazon rather than to local books.
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i love local bookstores, i spend as much time as i can in them. i also buy from amazon because they can get books to my house, and walmart prices are not just lower, they're 25% to 40% lower. and those prices, not just sort of well, this is good because prices are lower. this is a huge boon to the lowest fifth of the american consumer. to the people who are the least well off in the country. >> yes. >> also look at the costs of those prices, though. the cost of those prices is that you end up with walmart workers on welfare rolls. you look at towns and communities end up net poorer when the walmart is there because it's an extractive force rather than what she's got. >> this isn't quite true. no, no, no -- there's been pretty good research that has shown that walmart-style big-box retailing is responsible for about 50% of the u.s. productivity gains between 1995 and 2005. roughly. >> right. >> in that decade.
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>> overwhelming majority of which captured by capital rather than labor. >> but the prices have gone down. i think chris framed it really well. >> thank you, chris. >> no, seriously -- this pastoral notion that we're all going to go back to our lovely boutique stores, all of us, in all of our shopping, it's not going to happen, or, indeed, in all of our production, right? we're not also all going to buy all of our food from small-scale farmers. my dad, by the way, is a farmer. he farms our family farm, which is 6,000 acres. small is not viable in the modern -- >> i'm from the bronx, sounds huge to me. >> that's what i'm saying. small isn't visible in the modern tech logic economy. and that is a good thing because we enjoy a lot -- no, no, no -- but wait a minute. there are two problems. and they don't have to be inevitable. one is workers don't have to be exploited and there are laws and
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social movements, this happened in the 19th century with the industrial revolution. we still have the products, but workers -- >> you can be big and unionized. >> you said what's the problem with bigness? well, ultimately bigness is the network effect, it is monopolies. th that's why you had trust busting, and publishers getting together. >> i wanted to hear your thoughts on this as the operator of one of these dead-end boutique operators. >> there's no more independent bookstores, and in the last few years an increase in the number of independent bookstores. we're not asking people to shop with us because it's the right thing to do. we're bringing them in because what we do is good and it's what they want. but at the same time, we're not hoping to like take the place of other kinds of buying books. we're happy if people buy books wherever they are. but we do want an equal playing field. we want everyone to pay their sales tax, we want -- >> i want to -- >> i want to hear more about this level playing field. i think this actually gets to something pretty profound. and i also want to hear about,
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♪ [ female announcer ] swiffer. now with the scrubbing power of mr. clean magic eraser. we are talking about black friday and its sort of cultural significance in america and the role of retail and the future of retail. and you made this interesting point, jessica as a small business owner, about you're not, you know, you're fine with people -- with there being big options for people and small options for people, like your own. >> of course. >> you want a level playing field. and this is one of my favorite phrases in american politics, but what does that mean to you? >> everyone being asked to follow the same rules and a certain level of bigness not exempting you from rules like paying sales tax in your state, undergoing the amount of scrutiny, and standards, and having the same deals from your vendors and offering the same deals to your customers, i think all of that, you know, needs to be equal. >> amazon is the elephant in the
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room here, obviously. look at the revenue growth. amazon, i think people -- people know that amazon's huge, but you can't get your head around how big amazon is. and also how fast it's growing. and also the thing that's really crazy about amazon is usually enterprises are gaining market share in the beginning of their growth curve and then they're sort of holding on to it. amazon continues to grow and get bigger and gain market share, right? it keeps getting bigger and bigger, and the price to earnings ratio is massive. it's bigger than a lot of other companies because there's projection it has so much future growth. here's barack obama in 2007 talking about how he sees -- he's not talking about amazon, talking about walmart, but what he thinks are the issues with bigness of an enterprise like that. >> if there are workers who can't get the health care they need, who don't receive the wages they deserve, who are divided into two tiers, even when they do the same work, that's a threat to workers everywhere. and that matters to all of us.
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that's why what you're doing with walmart is so important. and that's why i was proud to join you in this effort on a call a few months back. i don't mind standing up for workers and letting walmart know they need to pay a decent wage and let folks organize. it isn't about attacking walmart, this is about demanding more responsibility from an extraordinarily profitable and successful company. it's about reminding that company that they have a stake in the communities where they set up shop. that the well being of their workers and other workers should matter to them, that opportunity and justice should factor in to their bottom line. that's not too much to ask for. >> that's then senator barack obama addressing the unions trying to organize walmart. i think the question is, is -- is -- are those two things possible to have together? which is bigness and also the kinds of accountability he's talking about? or is the problem that you get
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big enough, right, you say, well, it's fine if you're big, but also play on a level playing field like amazon. but the point is, when amazon gets big enough, it can muscle around different state legislatures. that's the issue it seems to me. >> it can be tackled. you think of teddy roosevelt, you can't talk to him, you can think about him. >> i probably get his name wrong. >> and that is why you do need anti-monopoly law and the technology sector lends itself, actually, to the creation of monopolies because you have the network -- >> network effects. >> that inevitably happens. >> briefly explain what network effects means for people that don't know the term. >> essentially there's this winner-take-all phenomenon where particularly in technology, google, facebook, i think we're seeing it with amazon. >> we saw it with windows before. >> right. where as one player becomes the dominant one, that dominance feeds upon itself because as
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more of us go there, it becomes a better place for us to go. so we all -- >> the question is, i'm going to choose an operating system and my choice is, well, what's going to be compatible with other people have. the more other people have windows, the more inclined you are to get windows. increasing returns as opposed to diminishing returns and flips our economic intuitions on their head. >> plus, when we have a playing field where the larger players cost of capital is lower than the smaller player, basically big companies can get money cheaper than little companies. that's when hacks like her bookstore become really interesting. because the real story of her bookstore is not that it's little, but it raised its capital from its community. so in some sense it's owned -- not investors in the sense that they're going to get money, but they're going to get discounted purchases for the rest of their natural lives. that makes the prices actually for me as a community member lower buying a book from her than buying it from walmart. >> i want to hear that story.
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so your bookstore raised capital in this very interesting way, which doug just brought up. explain how that happened. >> thanks, doug. i appreciate it. we had a business plan and we weren't actually able to get start-up financing from banks. they were pretty reluctant to loan to a small start-up, even though my business partner and i had years and years of experience in our field. we went to people in our community who were excited about the potential of a bookstore in their neighborhood. and said can you loan us anywhere from $1,000 to $10,000. if the bookstore gets off its feet, you get your money back, but it's kind of an act of faith. there was no guarantee that we actually were going to make a success of it. but people were willing to do that. and we raised about $75,000, which gave us enough to go to a bank and said we've got this beginning of it and we could get to where we needed to be, and now they're getting paid off, get discounts in the bookstore, our strongest supporters and
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it's been a great investment. but also very tangible. different from sort of putting your money in abstract investment, they can see it, walk in the store, talk to people who have jobs because our bookstore exists. >> if they write a book, do they get -- >> asking for a friend? asking for a friend? >> good for you. >> thank you. >> exactly. exactly. >> that highlights one thing about a place, the way that finance interacts with the real economy, and we talk about the level playing field. there is no level playing field in a too big to fail world of finance. that's one issue we talk about on the show. the other thing about it, people in the community are both -- and i said this earlier a little bit, we think about being a consumer as the sum total of your identity, or we're on the left, we talk about being a labor worker, and at this point people are investors, consumers, and community residents. the thing that rankles from my own kind of politics is the idea
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of interpreting people talking about people as consumers and not citizens, family members, and community members. this is why black friday is my favorite holiday, this is the title of your piece, because it embraces this. you think there's something kind of beautiful about this. >> i love the enthusiasm of commerce. it reminds me of a sporting event. you played that video of shoppers in georgia at a walmart earlier. that reminds me of a lot of rock concerts i went to as a kid and paid to be in the middle of that. and it becomes a sport, entertainment, and they get enjoyment and pleasure just out of that, just as there is an enjoyment and esthetic pleasure to going to a small bookstore. there's also a sort of a thrill to be in the crowd to wait in the line, it's just like -- it's -- >> that is a fair contrarian argument. >> -- a star wars movie. >> sure. >> what i would say to peter's point, not actually agreeing with my personal getting esthetic pleasure from that part of consumerism, but i think america treats human beings better in our manifestation as
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consumers than in our manifestation as citizens. >> that's a great point. >> i feel really well treated as a consumer here, exceedingly well treated. but i think as citizens -- and this is actually something that i think progressives need to do with government. if government treated you, as well, as google and amazon did, don't you think that americans would have more faith in government? >> right. >> my favorite -- one of my favorite on twitter made this point, you see how they're doing everything they can to accommodate the rush at black friday stores? maybe we should do that with voting. actually we make those provisions for voting. >> it's funny. it's like in spain, let the bulls loose and people go running. and here we open the walmart. but what we're also looking at, though, is the result of a suburban of a national landscape that was really intentionally developed to promote this kind of behavior. you know, when fdr met with the leavitt brothers to build levittown, they were not
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thinking about creating better citizens, how are we going to create a reality that requires each person to buy his own lawn mower, get their own snow blowers, so that we would grease the engines of corporate capitalism. >> we have taun a llked an awfu of esthetics today. and a lot of people can't -- >> i'm not talking -- >> no, no no -- >> but here's the billion dollar -- >> no, here's a point in savings iffer the lowest fifth -- >> there's a substantive point here too. there are benefits to low prices for low-wage earners, agreed. i don't think they sum out net benefit. but let me say this, we are -- we have seen the share of gdp that comes from consumption in america increase and increase and increase, now at 70%, place in canada, around 50%. we're growing, and 85% of gdp growth came from consumption. at a certain point, you just hit the brick wall. where the economy cannot grow any more from consumption.
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and that's a question for another day because i'd like to come back to that topic about just how much the american economy and the global economy can continue to count on the american consumer. >> we learned in 2008, that's when the rubber hit the road. >> it was all fueled by cheap credit. >> and i think quoting was the sort of social political response to income inequality. >> author of "life inc.," and jessica bagnulo the green light bookstore. thank you all for being here. the screen writer of the new film "lincoln," joins me. i'm so excited. right after this. so, i'm happy. sales go up... i'm happy. it went out today... i'm happy. what if she's not home? (together) she won't be happy. use ups! she can get a text alert, reroute... even reschedule her package. it's ups my choice.
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why tarnish your invaluable luster with a battle in the house? it's a rats nest in there. it's the same gang of talentless hicks and hacks who rejected the amendment ten months ago. we'll lose. >> i like our chances now. >> that exchange between daniel day lewis as abraham lincoln and david strathern as william seward, sparks the plot of "lincoln." playing now in theaters across the country, garnering critical acclaim, big box office numbers and a rush to hand lewis for best actor before anyone even announces next year's nominees. the most remarkable thing about the movie is to me, to focus not on the drama of war, but the understudied legislative battle. the one kicked off by that scene in which lincoln attempts to beg, borrow, and steal enough votes ending slavery through a
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skeptical and recalcitrant house of representatives during a lame-duck session. the film is a legislative caper, chronicle of counting votes in a pursuit of a great moral cause through degraded means. it's a movie about what is most elevated and most corrupt about democratic politics. the perfect and the good and the inescapable logic of compromise. it is to my mind the greatest sustained artistic meditation on these themes in the context of american politics i have ever seen. one with some very obvious resonance to our current political culture. and it is my great, great pleasure to welcome to the table one of the finest artists and writers of our time tony kushner. wonderful to have you here. >> thank you. >> congratulations on the success. >> thank you. >> you start out a project like this. i can't help but notice the evolution of the film "lincoln" took twice as long as the actual civil war. if i'm not mistaken. >> six years to write it and film it. two years longer. >> two years longer than the
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actual civil war. you start out and said we're going to do a movie about lincoln. and this is someone who more english words have been written about than anyone aside from e jesus and william shakespeare. >> how do you start out this project with that as your sort of portfolio? >> well, stephen was the one that decided, i think he had a conversation with doris 12 years ago and she mentioned she was writing a book about lincoln and he asked her if he could buy the rights then and there. he's been thinking about lincoln since he was a little boy. and decided, i think, about ten years ago he was really going to try and make a film of it. the original impetus was steven's. and when he hired me, my first question to him was whether or not before i said yes, whether or not we'd have to try and cover the whole war and all four years of the administration, which i knew before i started any serious research into
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lincoln was going to be a complete impossibility in a 2 1/2 hour film. and he immediately agreed that we could focus on a specific segment, portion of the administration. and he already decided he didn't want to do any of the big battles. he felt he did his big war film in "private ryan" and didn't need to do that again. and he bought doris' book, and doris' "lincoln" is a political lincoln. i think the path was sort of laid out before i even came in. and then i tried for two years to figure out how to condense about half of the -- i wanted to start in september of 1863 with his secretary of the treasury sort of coming out of the closet as an opponent, basically announcing he was going to run against lincoln for the republican nomination in '64. and chase is one of the great characters in american history and their relationship is really
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genuinely shakespearean. but after two years of trying, i never got any farther than january of 1864, i got like three months in. it was impossible to condense. then the writers guild went on strike, i had to stop writing, and after the strike was over, the spring of 2007, i had the idea of doing just the last four months which produced a 500-page screen play, the first quarter of which -- >> 500 pages about the last four months and then steven spielberg says let's focus on the 13th amendment now. >> i thought he was going to go for the last month, which was sort of march 18th to april 15th because that's when lincoln leaves washington for the longest time that he was out of washington during the entire war and went down to city point, grant's headquarters on the james river and then was present, basically, for the fall of petersburg and then the conquest of richmond, the capture of richmond and then
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famously went to richmond with his son and walked through the streets of the city the day after the city had fallen. and it was all very dramatic and very cinematic and i was certain that was going to be what attracted steven the most. but when i sent him this massive sort of phone book-sized script, it was the january stuff he immediately glomed on to. >> it's this amazing kind of hand-to-hand combat just to get enough votes to pass this. >> yeah. >> what did you learn about lincoln in writing this? because i think one of the things i think is great about him, he sort of captures lincoln's essential weirdness. >> right. >> it's this thing that comes up time and time again that you never quite see really nailed. he's such an odd figure. what else do you feel you learned about lincoln in the context of writing this? >> i was really happy that you said that after you saw the movie. i think he was a very strange man and you read in every contemporary account this kind
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of divided reaction to him within every person who meets him that he was kind of a lovely, warm, accessible human being and also something else was going on that was uncanny and unsettling. and people didn't find him an entirely comfortable presence ever. and many, many accounts of his sort of vanishing in the middle of a conversation and then coming back. and that was a bit of a surprise. you know, i really didn't know a lot about him. i'd read about three books, i think, before i started doing the research. i don't know that anything actually -- i think the only thing that would've surprised me was to learn that, you know, he hadn't written the second inaugural address or he wasn't the kind of great president i assumed that he was. but he really was astonishing. >> i think the most interesting relationship in the movie, actually, is between him and thaddeus stevens. right after we take this break.
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how can i hold that all men are created equal when here before me stands stinking the moral carcass of the gentleman from ohio proof that some men are interior, endowed by their maker by dim wits, imable to reason. you are more reptile than man, george. so low and flat that the foot of man is incapable of crushing you. >> how dare you. >> that is tommy lee jones as thaddeus stevens, probably the most prominent abolitionist during this period of time. and a real moral visionary. i think one of the things that's great about this film is, thaddeus stevens is one of the true moral beacons in american history. and i don't think we talk enough about him. and his conception of equality,
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i mean genuine equality between the races is ahead of even where we are today, i would even say. and -- what happens in the film is that we have this kind of -- these sort of two elements of progress. we have the kind of purity as channeled by thaddeus stevens and his sort of pristine moral vision and uncompromising attitude toward his foes as we see there. and then we have the practical lincoln. what do you want viewers to take away from that? the kind of dance between the two? >> well, partly just to show thaddeus stevens to the country because he's -- he appears in two films i know of. tennessee johnson and "birth of a nation," in both cases as a kind of devil. and even among lincoln historians, i think, he's not really not given his due because the radicals made life so difficult for lincoln for the entirety of his four years. february right after the
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amendment passed, the coalition that passed the amendment fell apart because congress began to jockey to get itself into position to take over reconstruction. part of stevens' vision of stripping all the southern states of state hood and would give congress control because congress readmits states. so they would -- and i wanted -- i think that the guy was an astonishing figure, great hero. his attitudes toward race feel like completely contemporary. he was an economic radical, which lincoln wasn't. he was kind of a socialist. he posed wall street and speculation on gold prices and so on. he was a visionary in many ways. and i think, you know, a very skilled politician, not a starry eyed guy.
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but like many of the people around lincoln at the time, somebody who didn't really understand how to pull off a trick of holding the country together, winning the war for the union, and slowly advancing towards the abolition of slavery. i think it took lincoln, actually, two years to realize that the civil war could only end when slavery was abolished. i mean, i think he understood that as a principle as early the house divided against itself, et cetera, et cetera. >> i think what's interesting about the politics of this film is that in the -- if you have thaddeus stevens as representing one kind of very pure, moral crusading moral vision and lincoln as the more practical operating and calculating means to achieve somewhat similar
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ends, the film seems to put a thumb on the scale of lincoln. thaddeus stevens comes across as a great man, but also that fundamentally when the chips are down and when you need progress to be made, the person that you want isn't the kind of -- >> right. >> the prophet. i wonder, did writing this change your own politics? did you come out of this with different politics than you went into it with? >> the eight years of bush preceding the -- i started during the bush administration, right, the miserable tail end. but watching the obama administration through a lincoln lens has been a great education for me. and my policies had already begun to change. i felt the kind of usual left impatience. and i think that impatience is enormously important. it's an engine, lincoln said it. he really preferred, he said, to deal with people of the left to people of the right because he felt the people of the left as
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he said had their eyes facing and people of the right on a couple of occasions were really primarily interested in aggregating their own power and there wasn't a whole lot. they were more susceptible to secession fever, for one thing, because the main thing for them was to stay in power and any kind of ideology was acceptable and we've seen recent examples of this. so, yeah, i think that there's such a thing, obviously, as too much patience with oppression and too much -- and it's easy to be patient when you're not the person immediately suffering. but on the other hand, too much impatience can make it impossible for anything to happen. i mean, you know, the crux of the civil war was that the border states had to stay with the union or the war couldn't conceivably be won. >> and lincoln craftily negotiated them staying there much to the chagrin of people
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like thaddeus stevens and the radicals. >> and all the way to 1864, the second election, they were still looking for somebody to replace lincoln. >> there are some interesting parallels with our own time, particularly the signature piece of legislation, the affordable care act. i want you to talk a little bit about that, our panel joins tony to talk about the obstacles still facing president obama right after this. [ woman ] ring. ring. progresso. i just finished a bowl of your new light chicken pot pie soup and it's so rich and creamy... is it really 100 calories? let me put you on webcan... ...lean roasted chicken... and a creamy broth mmm i can still see you. [ male announcer ] progresso. you gotta taste this soup. mmm i can still see you. try running four.ning a restaurant is hard, fortunately we've got ink. it gives us 5x the rewards on our internet, phone charges and cable, plus at office supply stores. rewards we put right back into our business. this is the only thing we've ever wanted to do
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oral-b power brushes. go to for the latest offers. starts with arthritis pain and a choice. take tylenol or take aleve, the #1 recommended pain reliever by orthopedic doctors. just two aleve can keep pain away all day. back to the news. hello from new york, i'm chris hayes here with tony kushner, claudia fagan, chief medical officer of cook county in chicago, illinois. and professor of political science at yale university. there was a whole lot of news this week about the affordable care act. and i think one of the things we can agree on about the election was it was in many ways, it ended up being, whether explicitly or implicitly a referendum on the affordable
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care act. this was the signature domestic achievement of the president. it was the precipitating event of the conservative backlash in the country as the tea party. and its fate was determined on election day inso far as whether it would stand or fall. and in reelecting president obama we're now going to have the act in some form. and the reason i wanted to keep you around for this conversation, tony, is because your film changed the way that i think of the affordable care act. i'm a supporter of the affordable care act and i think the outcome is really going to increase the net like joy of human beings in the country. but i'm serious, by a significant amount and reduce suffering. that's what we're all in the game for. at the same time, there was part of me that felt that the corrupt -- the corrupt -- the process that produced it and the way the process was tainted, you're cutting this deal with pharma, you're cutting this deal with the device manufacturers. then you've got to go over and say to the unions, okay, don't worry about the tax on the so-called cadillac plans, you're
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dealing everybody in because if you don't deal everybody in, the thing falls apart. there was something about the way in which that process unfolded that ultimately tainted my judgment of the final product, right? that like it's the -- it's the fruit of the poison tree. that you can't -- it can't be an ideal piece of legislation. it can't be something i can really, really get behind because i know all the dirty details of how it came about. and watching the story of how the 13th amendment was passed in which there are essentially just a bunch of hacks bribing congressmen made me think, well, i guess you can sort of separate means from ends. >> well, you know, i think one of the interesting things about democracy is i don't think means and ends are neatly divided. the means are the ends. i mean, the whole process of haggling through one of these bills is democracy itself. i mean, you're sort of achieving your ends while you're doing it. i think the affordable care act when we were working on the film during the health -- at one
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point we were in washington, i forget why, and obama was meeting with the republicans at blair house. so everything sort of came together for us then. you know, the moment was bart stupak and the public option. it felt like history happening all over again. and it seems to me that it's essential, you know, accepting compromise is essential because it advances us in terms of actually being able to cover more americans and giving us health care. it also shows it's possible to breakthrough barriers that we thought were, you know, i mean the idea that this first-term president, first-term african-american president was going to go to health care which supposedly undone, was an astonishing thing, everybody said it was a big mistake and he did it. and i think the election was a referendum on --
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>> you're both health care who watched this unfold. you're an actual doctor, a provider, and someone who drew up the original plan for the public option. and now we have passed it, what is the way that you go back and think about that process? >> well, you know, i guess the -- as politicians will tell you. being a pragmatist, a physician, taking care of patients that i'm not a good judge. i feel he compromised in the wrong places. i think he gave up too much too soon. my father was a labor union organizer, and he taught us that, you know, you never compromise until you get the other side at the table and you're looking eye-to-eye. and i felt like he didn't even consider single payer. my daughter jokes that single payer was off the table and on the floor. but if it had been in the room, then the nature of the compromise we got would've been quite different. >> this conversation ends up being -- what ends up happening
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is two conversations. the conversation about what are the best substantive outcomes? and then there are conversations, essentially our own individual subjective judgment of the wisest political choices, right? >> right. >> and i think sometimes we can conflate those, a moral overlayen o our own subjective judgments about what could've happened at what period of time. >> and i think it's a mistake to think that compromise only came after president obama was elected. the biggest shift in thinking about health care reform occurred prior to the election. after all, they were pushing a proposal that had been, you know, pushed by romney in massachusetts that had this public option, which i had pushed, but, you know, alongside a competitive market exchange structure. and that really structured the debate. so, you know, we should be clear that the compromises that occurred were really within the democratic party in a certain sense. there was hope to get
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republicans onboard, but in the end, only one republican in the house that supported the legislation. they weren't able to get any senate republicans despite the fact they had adopted an approach that borrowed heavily from republicans. so that was the really crucial moment. and my own view about it is that, you know, the public option was essential to kind of keeping the debate focused overall on how consolidated the insurance industry had become about the need to contain costs, about the fact that medicare does a good job controlling costs and covers people. now, i got a lot of flak from both sides, i mean, this is -- and i don't consider that a sign of virtue. if both sides attack you, you must be in the right place. i understood why that was. but i think the really sort of critical period in the debate occurred in deciding what the initial approach would be. >> that's interesting. >> and then, of course, during that period that ran roughly from late 2009 into 2010 when we
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went through four near-death experiences with the bill. >> that made me think also about -- let me just also say for the record, the 13th amendment is a much, much, much bigger deal in the affordable care act. lest anyone think i'm equating the two. much bigger two. >> yeah, absolutely ending slavery is a much bigger deal than anything, but the affordable care act is immensely significant. i think the difficulty here is to, you know -- and i think this is the difficulty. it's for progressive people. how do we develop a way. this is, again, you can borrow this from the history of lincoln and his relationship with the radicals and the house and the senate. how do we continue to -- how do we keep a public discussion alive about the things that are being compromised and what's being lost? and things like the public option while at the same time not undermining kind of a larger project, which is to rebuild
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politically effective progressive community in the united states. that seems to me to be in one sense what obama has taken on as president. it's going to be a big issue in the second term because i don't think he -- i think he's a builder and i don't think he's going to immediately become everybody's dream left president this time around either. so i think the question is how do we talk about this stuff without, you know, undermining the attempts to build? >> i think i must have come at all of this from a much more cynical angle than you, chris, because i don't expect any big legislative debate, especially one that involves so much of the federal budget like this one, not to look like this -- where you have to please all the various financially interested groups or at least enough of them to build a coalition to pass it. so i think, you know, i think on net the affordable care act is a good thing. i think there are a lot of problems with the way it's structured and there aren't enough measures to control costs. but i don't think it was reasonable to expect, you know,
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a law that would have been a lot closer to perfect to come out of the process. especially given that i think the republican approach on health care for the last 15 years has basically consisted -- with the exception of mitt romney as governor of massachusetts. >> the one person that delivered. i was also heartened, i remember, during the midst of it. the process of producing the bill. this is a fact. people hated it. they hated watching this process unfold. and it probably unfolded in some ways with more transparency than any similarly legislative battle in history. and i remember going back and reading about the labor -- the labor member of parliament in one of the chief architects of the national health service in britain. and of course, if you dive into that story, in that case it's the doctors, and at one point he declares the doctors won't shut up because they hate this and he says we shall stuff their mouths with gold. the way we're going to get them to shut up, carve things in the legislation that pay them off.
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it's the same kind of deal making that is in your film and that we saw on the affordable care act. >> yeah, but i think he's right that obama did frame the discussion. he could've framed the discussion around medicare and looking at an improved medicare for all. but he decided to go with the markets because he thought that would draw the republicans in. so he basically went to their side and failed in that regard because he wasn't able to -- >> to draw any of them off. i think the interesting lesson i take away from lincoln. there's some fantasy you have that the dispute will be resolved. will declare the end, right. okay, well, that's it. and we certainly saw this with the civil war, right? the noble cause lives on and resistance, resistance, resistance. the matter is never settled, and that's what i want to turn to next. we have the affordable care act, but there are still a tremendous amount of interests that are fighting it and fighting implementation. tony kushner, such a great joy and pleasure to have you this morning. thanks for coming in.
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welcome now to the table joy reed, we also have dr. donald burwich. happy thanksgiving, don. happy to have you here. >> nice to be here, chris. thank you. >> some big news this week in the world of the affordable care act and the implementation. and one of the things i think is important is, again, like i said, the matter is never settled. battles at every step of the way in the implementation and how the implementation goes is going to affect whether the legislation's successful. the regulations are promulgated, et cetera. the national federation of independent businesses was the
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name against the affordable care act. and the kind of person who has become the figure head of this resistance is the papa johns ceo. and he basically was a big romney supporter and he was saying before -- he said both before the election and actually in a conversation after the election that, well, look, our franchisees are going to reduce people's hours so they fall under the 30 hours that's covered by the employer mandate in the affordable care act. he then kind of walked that back a little bit. he said in an op-ed, he said, look, what did he say? here he says papa johns is still researching what the affordable care act means to our operations. regardless, we will honor this law as we do all laws and continue to offer 100% of papa johns workers health insurance as we have since the company was founded in 1984. that's the people that work directly for papa johns. the question is, though, the franchises. well, the average franchisee
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owns three to four stores, since they own the restaurants they operate and who they hire, how many hours they give each employee and what they pay each employee is up to them, not me or papa johns. like any small business, our franchisees are under tremendous amount of pressure on cost. i think the first big question is, are we going to see lots of businesses dropping health care because of the affordable care act? that is the threat. and i want to hear from you guys how credible that threat is. >> well, i mean -- there are two issues here, right, one is dropping employees down to part-time such that under the law they don't have to pay a penalty if they don't offer them health care and then also those employees will lose income because they don't work as many hours. and the other issue which is not necessarily so bad for the employees is companies saying it's cheaper to pay this $2,000 penalty than offer health plan. the employee can go buy in -- >> companies only over 50 employees this penalty applies to. and if you don't, you either have to offer them health insurance or they have to be
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making enough money that they could buy it in the individual marketplace unsubsidized. if you don't meet those criteria, you pay a $2,000 per employee fine. >> exactly. >> to the extent the companies decide i'm going to pay the fine. i think that's a perfectly okay outcome for workers. in the aggregate, you'll have a problem where it'll be more expensive than it was projected to be if companies decide to go that route. the real threat, i think, is this reduction to part-time for a lot of employees. and i think, you know, i'd certainly expect some companies to do it. they're responding rationally to incentives that they can save money and operate their business more profitably this way, they might well. >> two quick points. one is that employers are already dropping coverage. and so you ask -- >> that's been the trend. >> will there be employers dropping coverage and because of the affordable care act. now, the first part i think it is almost true, you'll see decline in employment-based coverage. over the course of the last decade, roughly a 10 percentage
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point decline in the share of employers providing coverage. but whether the affordable care act will accelerate that is an open question. and the other thing is, if employers are required -- above 50, are required to pay some modest amount, that could actually create a more level playing field. particularly among these sort of service employees who are not in international competition. >> don, is this something that you have thought about when you were thinking about how you design the regulations, how these decisions are going to be made at the margin by particularly, i think, smaller employers. >> yeah, at the margin. it was very hard to predict. there'll be some dust settling here. and we'll see, perhaps, some shift in the balance between public and private financing of health care. but the real key point to me is that the affordable care act isn't just about coverage, it's about delivery system reform. and the reason the employers are dropping back from coverage because the costs are out of control and the system needs to increase its quality. the whole part of the affordable care act that moves toward changing the way care is given,
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that will benefit employers and i think in the long run make it more possible for them to continue to offer the insurance directly. >> you're saying if it uses the mechanisms that are in place in the law, particularly using medicare and medicaid payments to reform the ways that health care are delivered to put an emphasis on quality as opposed to essentially quality, that's going to bring costs down and help everyone. >> it should if we follow through with the implementation of the affordable care act on the delivery system reform side. the coverage part of the affordable care act is the charismatic, more visible part of the law, people are debating who gets covered and who doesn't. but it's actually really crucial for the future of the system is the change of care delivery in the mechanisms. >> i think it's interesting, when there's a surplus of labor, then you can sort of have people like the guy from papa johns making this political calculation, i don't like the law, i'm not going to provide my franchisees won't provide their employees with health care. but as the economy improves -- >> if it tightens. >> yeah.
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>> now you have a more scarce supply of labor, offering health insurance becomes an incentive for businesses to hire and get quality employees. so i think this is an argument we can have now because of the surplus of labor. but as the economy improves, which inevitably it will, there's always a rebound from a recession, i think the calculation will be less political and more about your business. >> and economic logic to why employers before the affordable care act -- >> that's where it came from in the first place. the whole notion of linking your health insurance to your, you know, the employment was a way to engender loyalty and, you know, circumvent the wage and price freeze that the world war ii economy demanded. but make no mistake about it, the majority of people uninsured in this country today are working people. and that's been a trend. >> i want to talk about the people uninsured, half of whom, 15 million approximately are going to be added to the rolls through medicaid. are we going to see states run by the republican party take the federal government on its
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[ male announcer ] to learn more about the cold truth and save $1 visit alka-seltzer on facebook. so a huge part of the affordable care act's way of expanding coverage, the big thing. we have travesty, moral travesty, economic travesty in this country that we have people uninsured and one of the wealthiest countries ever existed in human history. and half of the people are going to get that coverage through these exchanges and half are going to get through expanded medicaid. one of the less noted part of the affordable care act came through the supreme court, essentially federal government could not force states to participate in the expansion. states could opt out. and we have seen a number of republican governors say we're opting out. the latest is governor mary fallon, rejecting oklahoma's participation. this is what she has to say about it. >> i have also decided that
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oklahoma will not be pursuing the expansion of medicaid. such an expansion would be unaffordable, also further oklahoma's reliance on federal money that may or may not be available in future years out, especially given the dire fiscal problems facing our federal government and certainly the discussion about the fiscal cliff in washington, d.c. >> now, just so people are clear here, the federal government will assume 93% of the costs of medicaid expansion from 2014 to 2022, that share will decline slightly after that. but this is a pretty good deal in terms of the amount of people you can get covered for the amount of money that you as a state are going to have to pay. after the decision, there was a lot of debate about basically will republican governors be that craven to turn away the money for the sake of political posturing, and a lot of people
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said, no, way, obviously they're going to come in line. as a person who ran cms, if you're surprised by these decisions or more or less what you're expecting. >> i'm surprised. it did take six or seven years, i think, when medicaid was first passed for all the states to sign on and we may be in some process like that. but it just doesn't make sense to leave this money on the table. these patients don't go away. a state that chooses not to participate in the medicaid expansion still has to somehow meet the needs of those people, whether free care pools or some forms of -- will end up being bills to the states, and as you said, chris, for the medicaid expansion portion of this, it's almost 100% federal dollars for the first few years and it goes down to 90% federal dollars. it just doesn't make economic sense for a state to leave that money on the table and as i said, patients are still there. they're going to come. >> well, i submit to you that a state like oklahoma may be able to get away with that. they have low medicaid rolls. states like florida, they're
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going to take the money. what's going to happen, the hospital interest will demand they take the money. >> now we're talking about the interest again. >> going to stuff their mouths with gold. hospitals will go bankrupt. i know in miami. >> it's a lifeline. >> hospitals on the brink of bankruptcy now. if they don't take the money, and hospitals are now corporations, they're huge bundled -- >> you work at a hospital -- >> and we actually just last month got a medicaid waiver, which will allow us to start in 2013 enrolling people and, you know, so -- >> ahead of schedule? >> ahead of schedule. what people don't understand, medicaid, you can't just be poor, you have to be poor and blind or poor and pregnant, or poor and disabled. this allows you to enroll people just on the basis of income. and for us, it is a lifeline. you know, 56% of the people in our hospitals are uninsured. 80% of our outpatients are uninsured. and the idea we can begin to get paid for these people is going to be about our survival.
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the way in which this expansion is being paid for is by decreasing the funds for disproportionate share hospitals. >> explain what that means. >> okay, so hospitals that take care of a large portion of people who are uninsured, indigent in this country receive funding for the government called disproportionate share. it's not that there's new money or free money, they're shifting the money. so we've made a decision. instead of paying the institutions, we're going to put the money in the hands of the individuals and then the individuals can make choices about where they want to receive their care. and it'll be up to the hospitals who take care of these patients to continue to attract them. because now they'll have medicaid and they can go have other options in terms of where they receive their care. >> interesting. >> and so we really -- we've made a decision instead of funding the institutions, we're now funding the individuals and then going to see if those individuals will continue to receive their care at those institutions or at other places. and i'm going to say that in a
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city like chicago, which is highly competitive health care market, they may have other hospitals other places that will take care of them. but we also have a lot of people who won't accept medicaid. >> right. >> and therefore, it's sort of like i said before to you, it's like giving someone a debit card with no credit on it. it might be a library card where there's no books in the library. >> i would say this leads to another point. not only is this a very cost-effective way of expanding coverage for the states, but a very cost-effective way of expanding coverage overall. one of the biggest bang for the buck ways to get people covered because medicaid's payments are relatively low. there's just some new studies, though, that suggest medicaid beneficiaries, although they have slightly higher -- slightly more difficulty getting care than do privately insured patients do so much better than people that don't have coverage at all. >> yes. >> my hope this is a high-stakes game of chicken with the states trying to extract more
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concession. >> don? >> yeah, and it is the states that are talking about leafing this money on the table this have the higher proportion of uninsured and potentially medicaid eligible people. >> and that's one of the things that's the strange aspect of the politics of all this, right? it is the states and we have a map of the states on the record saying it's oklahoma, texas, louisiana, mississippi, alabama, georgia, south carolina -- speaking of the civil war. josh. and i just think the politics of this are going to flip so fast once the program comes into effect. as don said, it was actually arizona did hold out for 17 years on medicaid. >> i saw that, it was like 1990. >> 1982. or '83. >> but they were alone for a substantial period in that. and that was the federal government only pays for 57% of medicaid on average. they'll be paying for north of 90% of the expansion. and these states will be paying federal taxes to finance obama care benefits in new york and california, and so you're going to be able to say to people, basically, look, we're paying for this, do you want this
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nearly free money or not? and i think the mind set right now, it's this denial thing where you stick your head in the sand and say we can repeal it and throwing as much at the law as possible and make the implementation as bumpy as possible. but jeenleventually the game win out. >> this is the way the federal government drug dealer gets you hooked is like they give you some free samples of medicaid and then like then you start jonesing for it and then they jack the price in the future? >> there may be. there are two things going on. there's a subtle thing at the margin. if a state can be -- can figure out a way to get a potential medicaid beneficiary on to the exchange that's 100% federal dollars, there's a little bit of that arbitrage going on. i think that on the whole, though, states will be far better off if they get into this. and i think they will. they'll realize their own self-interest lies there.
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and if they don't, the hospitals and doctors will insist. >> what's happening in florida right now, and rick scott is the ultimate tea party governor, but he's engendering the rage of the tea party. he's doing, he's using this free money to bargain with the federal government for ways to do experimental public/private weird sort of partnerships with the way they cover people. they're getting these waivers from health and human services to experiment the way they control coverage. a lot of these same states are saying they don't want to run their own exchanges. anti-federal government, but going to hand over -- >> that's the other thing. it's a very federalist law in certain ways. there's a fair amount of room for experimentation and latitude. and josh, you mentioned this sort of idea it could be repealed. this is the people calling for the repeal of the affordable care act is at an all-time low, 33%, the lowest it's been. this is from the kaiser polling, which has been doing polling. and you see that line dips down there. i think there was a conventional
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wisdom on the left, articulated by bill clinton, once this thing passes, people are going to love it. and that wasn't true. it took a while, but it does seem the public opinion battle has moved decisively. and i want to talk about the politics of continued resistance after this quick break. ♪ don't know what i'd do ♪ i'd have nothing to prove ♪ i'd have nothing to lose [ male announcer ] zales is the diamond store. take an extra 10 percent off storewide, now through sunday.
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wait! [ garth ] great businesses deserve great rewards. [ male announcer ] the spark business card from capital one. choose unlimited rewards with double miles or 2% cash back on every purchase, every day! what's in your wallet? [ cheers and applause ] tom berwick who used to run cms implementing the affordable care act. there was something you wanted to say before break. >> yeah, you were talking about gaming, and i wanted to point out one subtle thing around the fiscal cliff, i think the states are watching right now to see if this administration is going to stand behind the medicaid portion of the affordable care act or signal it's willing to back out the federal share. because, i think they really need a strong signal if they can rely on that federal match rate for a good long time. >> that's a great point. we do have some reporting about the last standoff around the debt ceiling, who was at the
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time the head of omb, the chief of staff, during negotiations, the republicans kept trying to chip away at the medicaid funding and he said no, no, no, no means no. but john boehner is making this point. who after the election basically said, look, guys, it's the law of the land, and that occasioned some histrionics. he now has an op-ed saying the president's health care law adds a massive expense. we can't afford it and can't afford to leave it intact. the law has to stay on the table as both parties discuss ways to solve our nation's massive debt challenge. boehner makes exactly the point you just made is that the republicans want to keep this in play and it's a real question about whether it's going to be in play. >> the nutty part of this is that obviously health care entitlements on the whole need to be on the table, not in the fiscal cliff discussion, but in the ultimate fiscal adjustment we'll have within the next few years where we shrink the federal deficit. but medicaid is the most cost
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effective part of our entire structure. if you're going to be cutting, cut in medicare, the exchange subsidies, medicaid is the last place to go to look for those dollars. >> the administration official after this op-ed from boehner told the huffington post, the president would oppose involving them in the negotiations. >> the aca reduces the deficit. so, i mean, if you look at the ten-year projections aca brings down overall costs. the subsidies and the medicaid expansion are costly, but there's also the savings in medicare and the new taxes that are going to be used to fund it. it actually on balance is deficit reducing. >> claudia, i'm curious, one of the things that's interesting, the single payer people and the conservative people, conservative opponents of aca and singer payer skeptics have similar critiques about cost control. you see mirror images, single payer people say no, single payer is the only way to get the
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cost control you want. i'm curious as someone who works on the ground in a hospital whether you think we're going to see the cost controls that materialize that are being projected? >> well, i'm very skeptical that the aca cost controls are going to be effective. i mean, you know, we could s say -- save $500 million if we did an expanded medicare for all, which would allow us to cover everyone including the people we're leaving out. the cost controls that we're talking -- the infrastructure isn't in place with the aca. >> you're saying on the delivery side. >> on the delivery side. >> and don, this is what you worked on, right. this is what you've done your life's work on, but also at cms is making sure the infrastructure is developed or in place to get the cost controls that are being projected. >> yeah, yeah, that's right. there's no question that a simplified system of payment would save money right off the top. but politically, we don't seem to be able to go there right now. the country's committed to a
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pluralistic system. i think the good news in the aca is the pluralism of state-by-state approaches to cost we're seeing around the country. it's exciting, oregon with community care organizations, massachusetts is trying a global cap. arkansas is pushing bundled payment to the limit. it's exciting to see what they're going to do if their new state legislature lets them proceed. maryland has an all-payer system, they're going to experiment more with. vermont may go single payer. we're going to see quite a bit of learning in the next few years as these states struggle with cost reduction. >> that's interesting, right? a lot of room for experimentation to see what is going to get the cost down. >> the one nice thing about having by far the highest health care costs in the world is it seems there are a large number of options you could pursue that would produce a better cost outcome than we have now. there are lots of countries that do not have a single payer system that have significantly lower costs than we do. >> everyone has lower costs than
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we do. >> well, one more reason medicaid will survive more than people think is the biggest sort of pot of money where you think the cuts are going to go. no one wants to touch social security is probably medicare. and if you do things on like changing the amount of benefits people get in medicare, people forget that one of the big things medicaid does, it helps poor seniors, and seniors are the most expensive to care for. so you're going to wind up having to have more medicaid money to cover those seniors who get caught in medicare. >> where do you think the politics of this will go as we see implementation. that's the real question. there's this window where we pass the law but it hadn't been implemented. people had their feelings about the law basically based on the process that passed it. and i'm curious to get your thoughts at the table about what is going to happen once it starts actually being parts of people's lives. with verizon.
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♪ you make me happy when skies are gray ♪ [ female announcer ] you know exactly what it takes to make them feel better. ♪ you make me happy [ female announcer ] that's why you choose children's tylenol. the same brand your mom trusted for you when you were young. ♪ how much i love you [ humming ] [ female announcer ] children's tylenol, the #1 brand of pain and fever relief recommended by pediatricians and used by moms decade after decade. [ humming ] one of the effects of the affordable care act, i think,
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from the political perspective is that as it begins to be implemented, the democratic party, barack obama in the short-term and the democratic party, i think, in the slightly medium term will own everything that happens in health care, right? it's like you guys did this thing, you passed the affordable care act and then if you're not liking your insurance company or your doctor or -- there is a big risk that's been taken politically here. employers were shedding the trend of shedding coverage was before the act. but after the act, people are going to say, well, that was the affordable care act. health care inflation going up way above regular inflation before the act. if that continues after the act, i wonder what you think the politics of this look like as it begins to become implemented. >> well, i think for the democrats, they've been waiting to have something to crow about. there's been small aspects of the law that have gone into effect. now there's going to be big steps. it's true, there are going to be messy moments, but there'll be people getting coverage, medicaid will be expanding,
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there's actually achievements to talk about. and i would say that the irony that everything made it hard to passing the act may now shift to be favorable toward implementation. so the gridlock, the difficulty of changing law works in favor of the affordable care act. the fact that all these -- you know, we had these insurance companies spending millions and providers groups spending millions. now they're going to have a vested interest in certain key elements of it coming to place. i think the politics going forward is not going to be pretty, but it's going to be very different. and the fact that the president was reelected means that there is a real change. i mean, this is a momentous shift. >> if you look at a state like south carolina, say they don't participate in the exchange. if people have a positive experience of the affordable care act, they're not going to say, well, my governor did a great job. they are directly being aided by the federal government. so i wonder if conservatives are not undermining their own argument for small government conservatism by letting the
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federal government take care of people. >> this is good policies, good politics, inso far as if you set up the exchanges well, then they're going to be popular, and if you don't, they won't be. >> yeah, therest a lot of good for people in the law. coverage under age 26 for kids, the prevention benefits, i think over 30 million people have used these now. insurance companies under much more restrictions to reduce their overhead costs. but i'd say the biggest vulnerability should be what you said, chris. it has to do with the exchanges. these are really difficult to set up. new information systems, complex enrollment procedures, and one of the tax is going to be try to starve them whether they are federal or state setting them up. that's going to be one of the real tests about the affordable care act. >> a really, really good point. >> i think one of the challenges on the cost side. i think this law takes even more of the responsibility within the economy for health care costs on to the federal government's books. and over time, those costs will be unsustainable. and the least popular parts of the law are the cost control
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parts. so, i think, you know, as it goes forward, more and more of the don berwick show. i think a lot of people don't like the show because that's the part where they're saying we're going to, you know, we're not going to give you this test because really, you know, the test isn't useful for you. >> and there's peer-reviewed evidence shows this test is not useful, and you say, gosh, darn it, i want the test. >> that's the change we're going to have to have. we would've needed it. >> we shouldn't kid ourselves that's necessarily going to be politically popular in all moments. >> i think it's going to be unpopular. >> of course. >> i want to thank dr. donald berwick. he said they're pushing bundled payments to the max, that's super exciting. the former administrator for the centers of medicare and medicaid services. joy reid, josh barro, dr. claudia fagin, and jacob hacker, professor at yale university. great conversation, thanks for getting up. and a final thought on what
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i'm grateful for this thanksgiving up next. [ female announcer ] over every holiday season your mouth has been snacking, gift stacking, nutcracking and yellowing. because if you're not whitening, you're yellowing. crest whitestrips remove over 10 years of stains, just in time for a white holiday. crest 3d white whitestrips.
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. have. . just a moment. what i'm grateful for this thanksgiving. a correction on something i said during my story of the week last sunday. while detailing the growth of the surveillance state in the context of former c.i.a. director's david petraeus. i showed u.s. request to google for user information. i said the 7,969 requests they received did not come with a warrant. that is not entirely accurate. google does not break out the number of government requests it receives by type offer how many come with a warrant and how many do not. it is likely that several types of the requests that google gets, such as court for wiretap orders would come with a warrant while many others would not.
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i regret the error. usually, we do now we know in this portion of the show. since we just celebrated thanksgiving, which also happens to be my favorite holiday. i thought i would take a moment to observe the very important ritual of expressing gratitude. one of very favorite people on twitter said, gratitude is first step in recognizing privilege, next step is to battle oppression that prop it up for hulk's country's beginnings to now. to say i'm thankful to have a job and health insurance, should question is whether that is a blessing at all. i am thankful for the opportunity to have spent thanksgiving with my wife and my child and my extended family, a source of joy unavailable to many of our troops including 68,000 americans currently serving in afghanistan. the families, both american and afghan of those that have died in the 11 years of war. i am thankful to live in a place where we have access to clean
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water electricity and we do not sleep away from the windows for worry of stray bullets. i am thankful i can feel some measure of control over my life and my future and not feel as though my fate is in the hands of a remote powerful sources armed to the teeth pursuing their own objectives and wreaking havoc in my own life. i'm thankful for all of the civil servants who day in and day out work to provide the basic public goods that are the underpinning for other kinds of human flourishing. from those at the federal aviation administration to oversee a commercial air travel regulatory system that keeps 25,000 flights a day safe and hasn't had a fatality in three years. to the tax processors of the internal revenue service who make the rest of governance possible. to the men and women that run our water treatment facility ises and the subway system workers that got the system back up and running in astonishly
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straight order after san did you flooded many of the stations and tunnels. i am thankful for this job which i love and the opportunity to do this, would. i am inorder dantley grateful to the crew here at "up with chris" as well as the staff, jonathan larson, kim harvey, todd cole, sal jen teal, allison coke, tara melter, diane shamus, katy grutry, chrisman alsaa and scott ross skoe who do rigorous, uncompromising journalist each and every week. we are extremely grateful there are viewers out there like yourselves, people who watch this show and argue with it and send me e-mail and tweets, both complimentary and occasionally enraged. i am generally thankful to live in this strange era in which technology puts us in close contact with our critics. brutal criticism forces us to think hard about what we are
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doing on this show and whether we are living up to the potential of this medium and the wonderful privilege of being able to talk to you every weekend. thank you for being so engaged and thank you for joining us today for "up." join us tomorrow, sunday morning at 8:00. we'll have democratic congressman, steve cone and the situation in gaza and the crazy news out of eyipt. mohamed morsi, one of the most fascinating world figures. one day i helps negotiate a cease-fire and the next doe layers himself a unilateral dictator. we are going to dive deep and look at the outcome and the winners from losers from the gaza situation and we will be talking about susan rice an the future of foreign policy. coming up next, melissa mayor ris perry. wi what will the first lady do with her second term? that and the definition of family when melissa harris perry ges gets going next.
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we'll see you right here tomorrow at 8:00. thanks for getting up.
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Up W Chris Hayes
MSNBC November 24, 2012 5:00am-7:00am PST

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TOPIC FREQUENCY Us 18, Thaddeus Stevens 8, Lincoln 6, America 5, Garth 3, Washington 3, Tony Kushner 3, Papa Johns 3, Don 3, South Carolina 3, Berwick 3, New York 3, Aleve 3, Richmond 3, Georgia 3, Massachusetts 3, Obama 2, Doris 2, Samsung 2, Greg Fletcher 2
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